DBT Training: Interpersonal Effectiveness Overview

In this and following sessions we will be covering skills for enhancing the following types of effectiveness. 

Objectives Effectiveness Skills (using skills to get what you want)
Relationship Effectiveness Skills (using skills to maintain/improve a relationship)
Self Respect Effectiveness Skills (using skills to maintain your self-respect)

These skills can help you:
- Take care of your relationships 

-  Balance priorities (your needs) with other's demands (other's needs) 

-  Balance wants (things that you want to do) with shoulds (things you ought to do) 

-  Build mastery and self respect 

Objectives Effectiveness, Goals

-          Getting what you want , getting your wishes taken seriously 

-          Standing up for your rights in such a way that they are taken seriously 

-          Requesting others to do things in such a way that they do it 

-          Refusing unwanted or unreasonable requests and making the refusal stick 

-          Resolving interpersonal conflict 

-          Getting your opinion/point of view taken seriously

It is important to remember that no one is able to get everything they want from others all of the time. Some environments are "similarly impervious" to even the most skilled individuals. Increased interpersonal skills will increase your probability of getting your objectives met. In situations where it is impossible to get what you want, distress tolerance and radical acceptance become important interpersonal skills.

Relationship Effectiveness, Goals The art of maintaining or even improving an interpersonal relationship while you try to get what you want. When this works well, you will get what you want, and the person may like or respect you even more than before.

-          Acting in a way that makes the other person want to give you what you are asking for  

-          Acting in a way that makes the other person feel good about your saying no to their request 

-          Balancing immediate (short-term) goals with what is good for the relationship

Sometimes your main goal is to get the other person to approve of you more, stop criticizing or rejecting you, stay with you. In this case relationship effectiveness refers to choosing a way to do this (improve the relationship) that does not do damage to the relationship in the long term. It is also important to remember that you have to balance relationship goals with the other two type of goals.

A: Relationship begins > person sacrifices needs and wants to keep the relationship > frustration and unmet needs, huge inequities > relationship ends: big fight, partner walks out or you leave the relationship in frustration 

B: Relationship begins > difficult situations dealt with > unmet needs assessed > inequity assessed > big issue addressed 

Self-Respect Effectiveness, Goals Self-respect effectiveness involves maintaining or improving your good feeling about yourself and respecting your own values or beliefs, while you try to get what you want. It includes: acting in ways that fit your sense of morality and acting in ways that make you feel competent.  Personally, I think this is the most consistently important form of personal effectiveness.

Things that diminish self-respect over the long term: 

-          Giving in for the sake of approval

-          Lying to please others

-          Acting helpless (also diminishes your sense of mastery)

DBT 11: Opposite to Emotion Action

Opposite to Emotion Action is another technique for changing negative emotions. The idea behind this technique is that it can help to deal with distressing emotions by setting into motion an action that is helpful, not harmful. Doing this counteracts the suffering you might otherwise feel because of the distressing emotion.  

For example, if we are angry, there are many actions that we might take to express our angry feelings. But if the action that we take is one that is opposite to the emotion we feel, like walking away from a situation when we are angry, or distracting ourselves with something nice, then we have put our energy into something that is eventually going to make us feel better. In this way, we not only reversed our action (walked away instead of yelling at someone), but we also began to make a change in our angry feelings. We didn't escalate or heighten our feelings, but did something that made the feelings decrease, by putting something positive in their place.

It's important to know that this skill is not about trying to suppress our emotions. We are using that angry feeling to take a different action. The result of this will be a gradual change in our emotions. It can be appropriate to use this technique when emotion mind is winning. Your emotions may be out of proportion, or escalating, or be emotions that we want to challenge or change. 

For example, if we are feeling very depressed and low and like no one wants us around and we might as well just stay in bed, a way to act opposite to the emotions is to get ourselves up and do something (go for a walk, go to the grocery store, visit a friend, etc.). We are not denying our emotion, but we are challenging it by acting opposite to it. Instead of staying at home in bed, we are getting up and going out. We may not see big changes, but little by little we will notice changes in the way we feel.

Examples:

FEAR 

·         Do what you are afraid of doing....OVER AND OVER AND OVER. 

·         Approach events, places, tasks, activities, people you are afraid of

·         Do things to give yourself a sense of CONTROL and MASTERY

·         When overwhelmed, make a list of small steps or tasks you can do

·         DO the first thing on the list

GUILT OR SHAME 

·         When guilt or shame is JUSTIFIED (emotion FITS your wise mind values) 

·         Repair the transgression

·         Apologize 

·         Make things better, do something nice for person you offended (or someone else if that is not possible)

·         Commit to avoiding that mistake in the future

·         Accept the consciences gracefully, then let it go

SADNESS OR DEPRESSION 

Get active, approach, don't avoid

Do things that make you feel competent and self-confident

ANGER 

Gently avoid the person you are angry with rather than attacking them (Avoid thinking about him or her rather than ruminating)

Do something nice rather than mean or attacking

Imagine sympathy and empathy for other person rather than blame

DBT 10: Letting Go of Negative Emotions

This section provides some techniques for letting go of emotional suffering. The best way to get rid of painful and negative emotions is to let them go. Letting go of emotional suffering associated with negative emotions is not the same thing as letting go of the emotions themselves. Letting go of the suffering is a process that we can learn.  We do not mean pushing away or sitting on the emotions. The emotions are valid, and represent experiences and interactions that were or are painful. What we are talking about is dealing with these emotions in a new way that will relieve some of the suffering that goes with them.

In learning to let go of our emotional suffering, we use our mindfulness skills, the observe and describe skills. We learn to get some distance from our emotions, to stand back and observe them. Try getting some distance from a painful emotion that you have. Put it over there and look at it, maybe as if it were on a screen or a stage. Describe in words what the experience of that emotion is like. This also helps to give you distance and perspective. By looking at your emotions, you are exposing yourself to them, looking and describing, not necessarily acting on them, and not being swallowed by or overwhelmed by them.

OBSERVE YOUR EMOTION
NOTE its presence
Step BACK
Get UNSTUCK from the emotion

EXPERIENCE YOUR EMOTION
As a WAVE, coming and going
Try not to BLOCK emotion
Try not to SUPPRESS emotion
Don't try to GET RID of emotion
Don't PUSH it away
Don't try to KEEP emotion around
Don't HOLD ON to it
Don't AMPLIFY it

REMEMBER YOU ARE NOT YOUR EMOTION
Do not necessarily ACT on your emotion.
Remember times when you have felt DIFFERENT

PRACTICE LOVING YOUR EMOTION
Don't JUDGE your emotion. Practice WILLINGNESS
Radically ACCEPT your emotion

DBT 9: Accentuate the Positives

Paying Attention To Positives

Increasing our positive reactions to events is another step in learning to deal with difficult situations. We need some positive emotions to put in the place of the negative emotions, or to share their space. This is not an effort to invalidate the negative emotions that we feel. It IS a way of expanding our experiences, and of providing some alternatives to some of our difficult times.  We can build positive emotional experiences through Short Term Experiences and Long Term Experiences.

Short Term Experiences  Short-term positive experiences could be something like a swim, a walk in the park, going out for pizza, watching a favorite TV show, talking on the phone to a friend. Most of us probably already do something like this in our lives. We are asking you to INCREASE doing pleasant things that give you positive emotions. Doing more of this makes us feel good, which we deserve, even in the midst of all the turmoil, and it gets us in the habit of having positive feelings.

Take a look at the Pleasant Events Schedule. For the next week, do ONE THING every day from this list of 176 activities. It's helpful if you plan what you are going to do early in the day, but you might want to do something spontaneously. I would challenge you to do at least one thing on the list that you have never tried before, maybe something you have been wanting to do. Enjoy yourself.

Long Term Experiences  In addition to having short term pleasant experiences, we also want to do things and make changes in our lives that will make positive events happen more often. Marsha Linehan often speaks of having "a life worth living." This is part of what makes life worth living.

GOALS  What are some things that you can do to make your life more worth living in the long term?  If you are going to school, or planning to go to school, you have a plan, and are working toward a goal. For some people, their job may be a goal in itself, or preparation for a goal (another more challenging or interesting or better-paying job). Perhaps you would like to move into your own apartment, or attend a treatment program, or move, or even buy a pair of Jimmy Choos. Maybe you may be learning or want to learn a skill or a craft, or take art lessons or swimming lessons, visit a friend or family member or travel in another country or buy a car. The possibilities are endless.  Think about what you would like to do to make your life more pleasant in the future. Make a list. Now list some small steps you can take toward your goals. Take a first step and build from there.

RELATIONSHIPS  Another important area to work on for a more positive future is relationships. This is not an easy area for most of us. But we can do some things that will help.

1. Repair a Relationship  If you really care about a relationship that has gone bad or just lapsed, work on repairing it. Perhaps you will be inspired to renew a relationship or to work to repair a relationship. The rewards can be great.

2. Create a New Relationship  We can also reach out for new relationships. You may wish to choose a community activity, like a club and attend regularly. You will see the same people over and over, and begin to chat and feel familiar. Invite someone you like for coffee or a walk.

3. Work on a Current Relationship  This could include spouses, partners, children, parents, siblings, friends, coworkers, anyone who is close to you or with whom you spend a lot of time. If you think that your positive feelings would improve by working on a present relationship, then give it a try. Don't let all your happiness depend on one person. Try to cultivate a variety of relationships. 

Positive Mindfulness  These last two points are really important if you are going to have and keep positive experiences in your life.

1. BE MINDFUL OF POSITIVE EXPERIENCES  To be mindful of positive experiences means applying mindfulness to the things that give you pleasure. Focus your attention on the positive things that happen or that you do - a talk with a friend, a walk in the woods, an ice cream cone, a good night's sleep, anything that you enjoy. Focus your attention on it, and if your attention wanders, refocus as many times as necessary. This will help to get you into the habit of experiencing pleasure.

2. BE UNMINDFUL OF WORRIES  Distract yourself from:

§  Thinking about when the positive experience will end

§  Thinking about whether you really deserve this positive experience

§     Thinking about what might be expected of you now that you've had this experience

One of the most important ways to work on negative feelings is to provide yourself with some positive experiences to take the place of the negative ones. It's much easier to let go of negative feelings when you have something positive to put in their place.  Enjoy your life!

DBT 8: Emotion Regulation & Reducing Vulnerability

What is Emotion Regulation?

Our emotions can frequently be very intense and labile, which means they change often. Our emotions often drive our behavior. A lot of our behavior focuses around finding ways to get our emotions validated or to get rid of the pain in some way.  Because of this, learning to regulate emotions is a central part of DBT. This does not mean that the emotions are invalid, and it does not mean that we are trying to get rid of them.  They are valid and important. But because emotions can cause pain or make us feeling out of control, we are going to first learn some things about our emotions and where they come from, and then we will learn some techniques about managing our emotions, reducing our vulnerability to negative emotions, and learning to experience some positive emotions so that we can keep things in perspective and stay in Wise Mind as much as possible.

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Primary and Secondary Emotions

There are primary and secondary emotions. The secondary emotion is the one that follows the primary or first emotion, for example, feeling shame because you got angry.  Anger is the primary emotion, and shame is the secondary emotion. A person can get angry for being angry, or depressed for being depressed, or angry for feeling fear.  In these three cases, anger, depression and anger are the secondary emotions.  It's important to be able to tell which emotions are the primary emotions and which are the secondary emotions.  Neither are good or bad, but to get back to the original problem and work on solving it, it is necessary usually to deal with the primary emotions.

The Function Of Emotions  Until we begin to understand the functions of emotions, why we have them, what their effect is on others, we cannot expect ourselves to change them.

DBT looks at three major functions of emotions:
1. Emotions Communicate to and Influence Others.
2. Emotions Organize and Motivate Action
3. Emotions Can be Self-Validating

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Emotions Communicate to and Influence Others.  We communicate our emotions to other with verbal and non-verbal language. Some expressions of emotion have an automatic effect on others. When there is a difference in what a person communicates non-verbally versus verbally, the other person will usually respond to the non-verbal expression. Non-verbal emotional expressions do not always match inside feelings so people can misunderstand what we are feeling.

Emotions Organize and Motivate Action  Emotions prepare for and motivate action. There is an action urge connected to specific emotions that is hard-wired. Emotions can also help us overcome obstacles in our environment. An example is the anxiety someone feels when they are about to take a test. This anxiety, though it's uncomfortable, helps to motivate you to study so you will do well on the test.

Emotions Can be Self-Validating Emotions can give us information about a situation or event. They can signal to us that something is going on.  Sometimes signals about a situation will be picked up unconsciously, and then we may have an emotional reaction, but not be sure what set off the reaction. Feeling "something doesn't feel right about this" or "I had a feeling something was going to happen and it did" are some of the signals we might get.  It can be difficult for people to acknowledge these emotions, because we have been in invalidating environments -- so much that we don't trust our emotions. If our emotions are minimized or invalidated, it's hard to get our needs taken seriously. So we may increase the intensity of our emotions in order to get our needs met. And then if we decrease the intensity of our emotions, we may find again that we are not taken seriously.

Describing Emotions.  Emotions involve what we call action urges. An important function of emotions is to prompt behaviors. For example if we feel angry, we may be prompted to fight. Or if we feel fear, we may be prompted to run or flee. The action itself, the fighting, or running, or hugging is not part of the emotion, but the urge to do the action, the feeling that prompts you to do the action, is considered part of the feeling.

Prompting Event. Emotions can be either reactions to events in the environment or to things inside a person. These events and things are called PROMPTING EVENTS. They prompt, or call forth the emotion. A person's thoughts, behaviors and physical reactions prompt emotions. Prompting events can be events happening in the present or a memory, a thought, or even another feeling (we feel ashamed, and then feel angry about feeling ashamed, for example). In managing our emotions, it is important to be able to recognize prompting events.

Interpretation of an Event or Experience.  Most events outside ourselves don't prompt emotions. It is the interpretation of the event that prompts the emotion. Can you see that the emotion comes after the interpretation is made, after you have the thought about the reason something is happening?

Body Changes.  Emotions involve body changes such as tensing and relaxing muscles, changes in heart rate, breathing rate, skin temperature, rises and falls in blood pressure, etc.  When we experience emotions, there are changes in our bodies. To regulate our emotions we have to be pretty good at sensing what is going on in our bodies. If we have practiced shutting off our body sensations, this can be difficult. However it is a learned response and we can unlearn it by practicing something else.

Action Urges.  An important thing that emotions do is to prompt behaviors. An action urge may be to fight or attack verbally in anger, or to flee or hide in fear, etc.  What are some action urges that you might have for these emotions: anger, fear, sadness, shame, disgust, surprise, etc.?

Expression and Communication.  One of the most important functions of emotions is to COMMUNICATE. To communicate something, an emotion has to be expressed. Sometimes, if we have not learned to express our emotions, we may think we are communicating but the other person isn't getting it. This can cause misunderstanding. Emotions are expressed by facial expressions, words and actions. Expressing emotions through behaviors can also cause problems, because different people interpret behaviors in different ways.

After Effects.  Emotions have after effects on our thoughts, our physical function and our behavior. Sometimes these effects can last quite a while. One after effect is that an emotion can keep triggering the same emotion over and over.

Reducing Vulnerability To Negative Emotion

This is a skills that we can use to keep ourselves less vulnerable to having negative emotions, and less likely to get into a state of Emotion Mind, where emotions control our thoughts and actions.  These skills are things that affect your physical and your mental well-being. If we are feeling sick, hungry, tired, under the influence of drugs, don't get much exercise or aren't doing something in our day that gives us a sense of mastery or accomplishment, we are more likely to be vulnerable to negative emotions, to experience or see the negative than the positive, less able to handle situations and interactions with our Wise Mind.
Linehan uses this chart as a way of remembering these skills, with the phrase "P L E A S E  M A S T E R."

treat PhysicaL illness
balance Eating
avoid mood-Altering drugs
balance Sleep
get Exercise
build M A S T E R y

P & L: Treat Physical illness  Do you have a physical illness that needs to be tended to? What things keep you from treating your physical illness? Take some time to think about this, and see what it would take for you to take care of your physical needs.

E: Balance Eating  How well do you eat? What kinds of food do you eat? What foods make you feel good? Calm? Energized? What foods make you feel bad? How does eating a lot of sugar make you feel? Caffeine? The key here is to eat foods that are healthy and that make you feel good.

A: Avoid Mood-Altering Drugs  Alcohol and drugs can lower resistance to certain negative emotions. For example, I found that when I drank alcohol, I felt more depressed and sometimes more frightened. If you use drugs or alcohol, notice how they make you feel.

S: Balance Sleep  How much sleep makes you feel good? Some people do fine on 5-6 hours, others need 9-10 hours. Some people need to nap during the day. Learn to plan your schedule so that you get the sleep you need.

E: Get Exercise  Regular exercise, besides being good for your heart, lungs, muscles and bones, stimulates endorphins in your brain which are natural antidepressants. We are talking about aerobic exercise, the kind that makes you out of breath.

MASTER: Build MASTERY  Do things every day that make you feel competent, confident, that you are good at something or are learning something. What kinds of things are you good at doing? Can you learn a new skill? What kinds of things give you a sense of mastery, of being good at something or meeting a challenge? Sometimes these things will be a little bit hard or challenging.

http://www.dbtselfhelp.com/html/print014.html

For more information about DBT, please visit the following links or Google Dialectical Behavior Therapy.
http://www.dbtselfhelp.com
http://www.behavioraltech.org

DBT 7: Distress Tolerance

Distress module provides important tools to help you to return to Wise Mind when your emotions become too powerful.  These are not permanent avoidance tactics. They are simple and important outs which will allow you a breather so that you can refocus, return to mindfulness and act effectively.  Important in this too are tools for self soothing and handling painful situations in non-judgmental ways.  They help you to accept reality even if you don’t approve of what’s going on. 

Distress Tolerance: Crisis Survival Strategies

DBT teaches us four sets of skills for tolerating (dealing with, getting through, accepting) the distressing events and activities in our lives. We can think of these as Crisis Survival Strategies. Some of them will fit and feel right, others won’t. Out of these skills, it is recommended to try them all and identify which especially work or apply to you. They are:

·         Distracting - Wise Mind ACCEPTS

·         Self-Soothing

·         Improving the Moment

·         Thinking of Pros and Cons

DBT emphasizes learning to handle difficult situations skillfully. The ability to tolerate and accept distress is an essential mental health goal for at least two reasons.

1.      Pain and distress are a part of life; they cannot be entirely avoided or removed. The inability to accept this immutable fact itself leads to increased pain and suffering.

2.      Distress tolerance, at least over the short run, is part and parcel of any attempt to change oneself; otherwise, impulsive actions will interfere with efforts to establish desired changes.

Although the stance advocated here is a nonjudgmental one, this should not be understood to mean that it is one of approval. It is especially important that this distinction be made clear to clients: Acceptance of reality is not equivalent to approval of reality.

Crisis Survival Strategies  The following are techniques to give you a break from dealing with negative emotions temporarily. They give you a break and allow you to transition from emotional mind to wise mind in order to effectively handle the situation.

DISTRACT (to reduce contact with emotional stimuli )
A useful way to remember these skills is the phrase Wise Mind ACCEPTS

Distract with Activities: Activity raises endorphin levels and gets you out of the crisis situation for a while. Do hobbies, watch a video, go for a walk, play a sport, cook, garden, go fishing, go shopping. 

·         What other activities can you think of that you can get involved in and distract yourself from your distress? Make a list of your activities and keep that handy so that you can relate to it when needed.

Distract with Contributing: Do volunteer work and contribute. Babysit so a friend can go out. Do something nice or surprisingly thoughtful for someone.

·         What have you done this week to contribute? What can you do next week to contribute? Plan something in advance. This takes you away from your pain and puts your attention on your concern for someone else.

Distract with Comparisons: Compare yourself to people coping the same as or less well than you. If you are doing better than you were a year or two ago, make that comparison. Watch disaster movies, watch soap operas, or a hospital waiting room. Some people find this helpful, others don't. Just do what works for you.

Distract with opposite Emotions.  Do something to evoke the opposite emotion to what you are feeling. If you are sad, watch a comedy or amusing anecdote. This helps to put you in a different place.

With Pushing Away  (use this skill last - as a tuning out): Push the situation away by leaving it for a while, leave the situation mentally or physically. Build an imaginary wall between yourself and the situation or push the situation away by blocking it out of your mind. Censor ruminating. Refuse to think about the painful aspects of the situation. Put the pain on a shelf. Box it up and put it away for a while.

Distract with other Thoughts  This is essentially a mini-meditation. Some examples are counting to 10 or counting the tiles in a floor or the panes in a window or the stars in the sky, anything to keep your focus on the counting.  This is a good one to use in a sudden emergency, when you need to pull something out of your bag of tricks really quickly. You may also try reading, watching TV or movies, doing crossword puzzles, writing poetry.

Distract with other Sensations. (other intense sensations): Hold ice in your hand, squeeze a rubber ball very hard, take a hot shower, listen to loud music, sex, snap a rubber band on your wrist, suck on a lemon. Any of these will help you to avert crisis.

Again, these are not permanent avoidance techniques. They are tools and avenues to take when your emotions are too hot to act effectively. They are good transitions back to wise mind and mentally give you a break from a difficult situation.

SELF SOOTHE  A way to remember these skills is to think of soothing each of your FIVE SENSES

With VISION:
Buy one beautiful flower, make one space in a room pretty, light a candle and watch the flame. Set a pretty place at the table, using your best things for a meal. Go to a museum with beautiful art. Go sit in the lobby of a beautiful old hotel. Look at nature around you. Go out in the middle of the night and watch the stars. Walk in a pretty part of the town. Fix your nails so they look pretty. Look at beautiful pictures in a book. Go to a ballet or other dance performance, or watch one on TV. Be mindful of each sight that passes in front of you, not lingering on any. Notice your appreciation.

With HEARING:
Listen to beautiful or soothing music, or to invigorating and exciting music. Pay attention to sounds of nature like waves, birds rainfall, rustling leaves. Sing your favorite songs, hum a soothing tune, learn to play an instrument. Call 800 or other information numbers to hear a human voice. Be mindful of any sounds that come your way, letting them go in one ear and out the other.

With SMELL:
Use your favorite perfume or lotions, or try them on in the store, spray fragrance in the air, light a scented candle. Put lemon oil on your furniture. Put potpourris in a bowl in your room. Boil cinnamon, bake cookies, cake or bread. Smell the roses. Walk in a wooded area and mindfully breathe in the fresh smells of nature.

With TASTE:
Have a good meal, have a favorite soothing drink, such as herbal tea or hot chocolate (but no alcohol). Treat yourself to a dessert. Put whipped cream on your coffee. Sample flavors at an ice cream store. Suck on a piece of peppermint candy. Chew your favorite gum. Get a little bit of special food you don't usually spend the money on, such as fresh squeezed orange juice or organic vegetables. Really taste the food you eat, eating one thing mindfully and focusing on its taste.

With TOUCH: Experience whatever you are touching, notice that the touch is soothing. Take a bubble bath, put clean sheets on the bed, pet your dog or cat, have a massage, soak your feet, put creamy lotion on your whole body. Put a cold compress on your forehead, sink into a really comfortable chair in a hotel lobby or in your home, put on a silky blouse, dress, or scarf. Try on fur-lined gloves. Brush your hair for a long time. Hug someone.

IMPROVE THE MOMENT: A way to remember these skills is in the word IMPROVE

With IMAGERY: Imagine very relaxing scenes or soldiers fighting and winning. Imagine a secret room within yourself, seeing how it is decorated. Go into the room whenever you feel threatened. Close the door on anything that can hurt you. Imagine everything going well. Imagine coping well. Imagine hurtful emotions draining out of you like water out of a pipe.

With MEANING: Find or create some purpose, meaning or value in physical or emotional pain. Remember, listen to, or read about spiritual values. Focus on whatever positive aspects of a painful situation you can find. Repeat them over and over in your mind. Make lemonade out of lemons. Endurance is the lesson.

With PRAYER: Open your heart to spirituality. It could be a God, nature or your own wise mind for instance.

With RELAXATION:  Try relaxing each large muscle group, starting with your hands and arms, going to the top of your head, and then working down. Listen to a relaxation tape, exercise hard, take a hot bath, or get a massage. Breathe deeply, half-smile, change your facial expression. Just the act of smiling will uplift you. Try a smile even when you are upset.

With ONE THING IN THE MOMENT:  Focus your entire attention on just what you are doing right now. Keep yourself in the very moment you are in. Focus your entire attention on physical sensations that accompany nonjudgmental tasks. (e.g. walking, washing, doing dishes, cleaning, fixing). Be aware of how your body moves during each task. Do awareness exercises.

With VACATION: Give yourself a brief vacation. For instance, from 2 p.m. to 4 p.m., get in bed and pull the covers over your head for 20 minutes. Rent a hotel room at the beach or in the woods for a day or two. Unplug your phone for a day, or let your answering machine screen your calls. Take a 1 hour breather from work that needs to be done. Look at a magazine, bundle up in a chair, eat slowly. Allow yourself to be a kid again - take a break from adulthood.

With ENCOURAGEMENT: Cheer lead yourself. Repeat over and over: “I can make it. This won't last forever. I will make it out of this. I'm doing the best I can. I can do it. There’s a lesson to learn here.”

Thinking of PROS and CONS 

·         Make a list of the pros and cons of tolerating the distress. Make another list of the pros and cons of not tolerating the distress - that is, of coping by hurting yourself, abusing alcohol, or drugs, or doing something else impulsive.     

·         Focus on long-term goals, the light at the end of the tunnel. Remember times when pain has ended. Think of the positive consequences of tolerating the distress.

·         Imagine in your mind how good you will feel if you achieve your goals, if you don't act impulsively.

·         Think of all of the negative consequences of not tolerating your current distress. Remember what has happened in the past when you have acted impulsively to escape the moment. Ask yourself, “Will this event that is distressing me going to matter in 5 years?”

DBT 6: Mind States – Accessing Your Wise Mind

Mind States – Accessing Your Wise Mind
To review: the central concept of DBT is mindfulness. The concept of mindfulness comes from both Western and especially Eastern (Zen) meditation and spiritual practices. Mindfulness means being in the present, being aware of what is happening and what you are doing, observing what is going on, participating fully in what is going on around you. It is a skill that is practiced and learned throughout DBT, little bit by little bit.  By learning to live in the present, you can have a life that is more in tune with your goals. The three primary states of mind are Reasonable Mind, Emotion Mind and Wise Mind. Reasonable Mind A person is in Reasonable Mind when they are approaching things intellectually, thinking logically, planning behavior, paying attention to empirical facts (facts that can be observed or measured or counted), focusing their attention, and when they are "cool," that is, not emotional in their approach to solving problems. Consider: What are some examples of the way you use Reasonable Mind? How can Reasonable Mind be helpful? Can you think of any times when it is not helpful to be in Reasonable Mind? Emotion Mind  A person is in Emotion Mind when their thinking and behavior are controlled mostly by their emotions.  Logical thinking and planning are difficult, facts may be distorted or made larger or more important, thoughts and behaviors might be said to be "hot," and the energy of the behavior tends to match the intensity of the feelings. Emotion Mind is reactive. Some examples of emotion mind might be: ·  having a fight with someone you disagree with ·  going on a trip on an impulse, without planning ·  going out to fly a kite just for the fun of it ·  snapping at a salesperson because they don't have the item you want Consider: What do you do when you are in Emotion Mind? In what ways can it be helpful or good to be in Emotion Mind? What are ways that it might not be helpful to be in Emotion Mind? Wise Mind Wise Mind is the coming together, the overlap of Reasonable Mind and Emotion Mind. In this overlap, they produce something bigger than either of them were separately. What is added is intuition, a feeling of "knowing" what's right, the right thing to do or the right way for things to be.  You can experience intuition about what's right or appropriate without thinking about it; the wisdom becomes natural. As you bring Wise Mind skills to problems, you will develop mastery. Mastery, the feeling of being competent and under control, does NOT mean you won’t make mistakes. Keep practicing. "Wise mind is that part of each person that can know and experience truth. It is where the person knows something to be true or valid. It is almost always quiet, It has a certain peace. It is where the person knows something in a centered way." (Linehan) Sometimes you may access wisdom when suddenly confronted by another person and stay calm under pressure. Sometimes you may find that in the midst of crisis you intuitively know the right thing to do. Sometimes approaching a difficult problem generates an insight that unlocks an inner door. Sometimes Wise Mind is seeing the whole picture not just the parts. Sometimes when faced with a difficult dilemma, Wise Mind reveals a clear choice. You will develop self-agency and self-awareness as you develop mindfulness, regulate your emotions, are effective interpersonally, and tolerate distress. Self-agency is the feeling you have when you are in control of your own behavior. Rather than feeling your behavior just happens, self-agency owns the behavior and takes responsibility for it. Self-awareness is the sense you have that your different roles, feelings, attitudes, and mental states fit together coherently. Qualities of Wise Mind Wise Mind is calm. It is almost always quiet and peaceful. When change or acceptance is necessary Wise mind is the serenity of knowing which course to take. Wise Mind is not trapped in all-or-nothing thinking and can focus on what is effective and functional. In Wise Mind, you are in control of emotional mind. Behavior is not mood dependent (controlled by one’s emotions) but at the service of one’s inner wisdom. Eventually, objective self-observation and self-description are attainable from this slightly detached point of view. In fact, you can learn to experience extreme emotions like anger or fear while staying in Wise Mind. This takes lots of practice – for everybody. Likewise, in Wise Mind, you are able to access the knowledge of reasonable mind. Wise Mind is courageous, i.e. feels scared but does what is needed in the situation anyway. Willingness is doing what is needed in each situation. Willingness often requires courage. Wise Mind is confident. Self-confidence is knowing you can handle whatever problems in life comes along. When Wise Mind becomes clear, fear disappears. Wise Mind knows you are doing the best you can under the circumstances. When you skillfully approach your problems, you are in Wise Mind and doing the best you can. Through mindfulness, you will develop the skills to access your Wise Mind. With Wise Mind as the basis for problem solving, you will improve the quality of your life. Everyone has this Wise Mind. Some of you may not have found it yet.  But it is important that you learn to find a place of calmness inside you, to let go of the intense emotions, so that you can sense the wisdom inside you. Some of you will experience Wise Mind after a crisis. It is like the calm after the storm.

Meditation and Wise Mind

Mindfulness exercises like meditation develop inner calm, emotional control, perseverance, and a strong sense of self. Meditation heals the damage of stress. One of the simplest meditation exercises is to follow your breathing. When you meditate on your breath, you can find Wise Mind in the physical center found at the bottom of your inhalation. You can develop the ability to find your center during meditation and get to know this calm centered place well. If you learn where your center is and how it feels, you can go to this place, confident that you are responding in Wise Mind. Although meditation may be unfamiliar, you can cultivate the ability to be mindful.

Meditation and mindfulness develop your ability to observe what is going on within yourself in any situation. One way that people commonly experience this is to step back from one’s thoughts and feelings and release your attachment to these mental phenomena. The goal here is to reflect on your thinking and feeling, independent of the circumstances, observing what is going on in one’s mind like watching clouds drift through the sky.

Consider:

Do you ever have this intuition that something just "feels right?" The right thing to do or say or plan for? Could you give us an example?

Do you have other ways of knowing this? This is what we mean by Wise Mind. It takes into account your logical thinking and planning and your emotions, but it's something more, a place of calmness and wisdom.

DBT 5: Being Effective - Doing What Works

Lesson 5: Being Effective - Doing What Works

The goal of this lesson is to focus on being effective -- to focus on doing what works, rather than what is "right" versus "wrong" or "fair" versus "unfair."  Another way to think of it is as the opposite of "cutting off your nose to spite your face." In our study of mindfulness as it applies to DBT Skills, we have looked at: states of mind (reasonable/wise/emotion mind), the mindfulness "what" skills (observing, describing, participating), and two of the mindfulness "how" skills (taking a nonjudgmental stance, focusing on one thing in the moment).  We will now add the third mindfulness "how" skill:  Being Effective. This is directed at reducing our tendency at times to be more concerned with what is "right" than with doing what is actually needed or called for in a particular situation.

“A central issue for many of us is whether we can indeed trust our own perceptions judgments, and decisions -- that is, whether we can expect our own actions to be correct or "right."  However, taken to an extreme, an emphasis on principles over outcome can often result in our being disappointed or alienating others. In the end, everyone has to "give in" some of the time.  It can be much easier to give up being right for being effective when we view it as a skillful response.” (see Marsha Linehan, p. 64-65)

It seems that Effectiveness is often tied up with “Radical Acceptance,” one of the Distress Tolerance skills we will learn about. I don’t have to like the situation or agree with the other person. Even if I am right and the other person is clearly “wrong,” it might be most effective to let it go. In order to help me achieve an effective outcome and maintain balance, I can radically accept the situation. It’s all about economy of energy and overall effectiveness. Sometimes, it’s worth losing a battle to win the war. You have an overall objective in each encounter.  Keep that in mind, and let that objective help to guide your responses.

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Exercises

·  Do you remember the last time you "cut off your nose to spite your face" just to make a point? Have you ever played by the rules to get something you really needed, e.g.,  health care for yourself or another family member? How did that feel at the time?  (Perhaps you felt like you were sacrificing some of your self-respect for the sake of achieving your objective.)   How do you feel about it now? (Perhaps you feel like you acted effectively.)

·  Are there situations in your life right now where vengeance, useless anger or righteousness are keeping your from being effective?

DBT 4 - One Mindfulness: One Thing at a Time

DBT 4 - One Mindfulness: One Thing at a Time

Marsha Linehan has drawn these skills from Eastern and Western meditation practices, and related them to psychological and behavioral techniques. Mindfulness has to do with the quality of awareness that we bring to what we are doing and experiencing, to being in the here and now.  It has to do with learning to focus on being in the present, to focusing our attention on what we are doing and what is happening in the present. We have to learn to control our attention. Many of us are distracted by images, thoughts and feelings of the past, perhaps dissociating, worrying about the future, negative moods and anxieties about the present.   Sometimes, it can be difficult to put these things away and concentrate on the task at hand but it’s worthwhile. You will find your effectiveness improve, even if it may seem that you are slowing down. That perception will bring you peace while your output actually increases. So the one-mindfulness skill is an effort to help us focus our attention on the here and now – one thing at a time - to be able to absorb the DBT information and take part in the present. This can be a difficult skill for people to learn. It requires lots of practice and willingness. Be patient with yourself. Overview The ideal of one-mindfully is to do one thing at a time. If you are going to eat, eat.  Don't read or watch TV at the same time. The reasons for this are so that you can give your full attention to what you are doing and do your best job, but ALSO so that you will feel completely present and not fragmented when you are doing these important things. One of the ways to approach the idea of mindfulness and one-mindfully is through learning to breathe mindfully, or conscious breathing. Our breathing goes on all the time, but mostly it's not conscious. We are not thinking about it. Conscious Breathing Conscious breathing and meditation are other ways of staying one-mindful. As you breathe in, notice that you are breathing in. As you breathe out, notice that sensation.  Don’t hold onto anything. Notice the important connection between your mind and body as the fresh air nourishes your body. This technique can help you keep your mind on your breath. As you practice, your breath will become peaceful and gentle and your mind and body will also become peaceful and gentle. This is not a difficult exercise. In just a few minutes you can realize the fruit of meditation. A Day of Mindfulness You may consider trying a day of Mindfulness as practice. If an entire day of it seems like too much mindfulness, try performing a task without ANY thought of getting it over with.

Photography is a mindfulness activity. It requires focus to find something worthwhile in the rubble.  

Think of one that you might be able to practice!